To find out the sensitivity of motor conduction tests and the change of distal latencies, we examined 60 hands of 30 patients referred with clinically diagnosed carpal tunnel syndrome (CTS) and 30 hands of 15 healthy women. Such tests included abductor pollicis brevis distal latency (APB DL), lumbricalis distal latency (LUMB DL), interosseous distal latency (INT DL), lumbricalis-interosseous distal latency difference (LUMB-INT), as well as the difference between APB DL and LUMB DL (APB DL-LUMB DL). The sensitivity of the tests were calculated in accordance with published recommendations (American Association of Electrodiagnostic Medicine 1993). The sensitivities of APB DL, LUMB DL, the combination of the two tests were respectively 88.4, 69.8, 100%. The combination of APB DL and LUMB DL seemed to be useful for diagnosis of mild CTS as well as sensory distal latency of the ring finger. The APB DL-LUMB DL was much prolonged in clinical CTS patients with the APB DL over 6.0ms. The APB DL tended to be more delayed than the LUMB DL, because median motor fibers innervating thenar muscles are more vulnerable to compression than those innervating lumbricalis. It is recommended to record the APB DL and LUMB DL and to calculate the APB DL-LUMB DL in order to diagnose as mild CTS and evaluate the pathology of CTS.

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In this study, we investigated the characteristics of urinary disturbances in acute states of stroke and evaluated the treatment methods. The subjects were 148 patients who were admitted on the day of onset of stroke. Age at admission ranged from 25 to 88 years old (mean±SD: 66.6±12.4), and 98 subjects were male and 50 female. Of these patients, 97 demonstrated cerebral infarction, and the remaining 51 demonstrated intracerebral hemorrhage. The severity of urinary disturbances was classified into 4 types by urodynamic study and managing method of the urinary tract: I, II, IIIa and IIIb. Type I patients had no urinary disturbances. Type II patients had a balloon catheter inserted into the bladder, but subsequently did not require medication for urinary disturbances. Type IIIa patients and type IIIb patients were treated by insertion of a balloon catheter into the bladder, and also required treatment for urinary disturbances. Type IIIa patients demonstrated dysfunction of the detrusor muscle and type IIIb demonstrated detrusor-sphincter dyssynergia. All patients were classified into 4 types and were examined regarding the relationship between the severity of urinary disturbances and their sex, age, symptoms on admission and type and location of cerebrovascular disease. Eighty-three patients were classified as type I, 31 as type II, 25 as type IIIa and 9 as type IIIb. The motor functional level of the lower limbs on admission was evaluated using Brunnstrom's staging. The findings were as follows: 1. Type I was observed in 65 (66.3%) of male patients, and in 18 (36.0%) female patients. Type I was also observed in 51 (66.2%) of 77 patients under 65 years old age, and in 32 (45.1%) of 71 patients 65 years or more. Type I was observed more frequently in male than in female patients [p<0.001: x² test], and in patients under 65 years of age [p<0.01]. 2. Type III was observed in 17 (34.0%) female patients, and in 17 (17.3%) male patients. Similarly, type III was observed in 22 (31.0%) patients 65 years or more, and in 16 (15.6%) under 65 years of age. Type III was observed more frequently in female patients [p<0.05], and in patients 65 years or more [p<0.05]. All type IIIb patients were 70 years or more. 3. Type III was observed more frequently in patients with severe cerebral infarction and intracerebral hemorrhage. 4. Patients with a balloon catheter inserted into the bladder were those with consciousness impairment (CI), deep sensory disturbance and anosognosia (AG) on admission [p<0.01: multivariate analysis]. Type III patients were those with CI [p<0.01] and AG [p<0.05] on admission. Therefore, there was a marked correlation between the severity of urinary disturbances and the sex, age of patients and their symptoms in the acute state of stroke.

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This study was carried out to evaluate the effectiveness of various forms of quadriceps isometric exercises to facilitate the activity of the medial vastus muscle over that of the lateral vastus muscle. Five quadriceps isometric exercises were studied in 15 healthy volunteers (15 limbs) and 11 patients (15 limbs) with disuse quadriceps muscular atrophy. The amplitude of the integrated surface-EMG was evaluated for the medial vastus, lateral vastus and femoral rectus muscles. The quadriceps setting exercise in conjunction with isometric contraction of the hip adductor muscles in the foot-supinated standing position demonstrated the highest value in the ratio of medial vastus to lateral vastus muscle activity (VM/VL). It was found that this quadriceps isometric exercise facilitates the activity of the medial vastus muscle over the lateral vastus muscle.

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The subjects were 18 MRSA (Methicillin-Resistant Staphylococcus Aureus) positive inpatients (67.7±8.8 y. o., 12 men and 6 women, 16 strokes, and each one of traumatic brain injury, and ischemic encephalopathy). The patients were classified into 2 groups according to the level of isolation and managements; closed management group (9 patients, strict isolation with gown techniques and only bed side rehabilitation) and semi-closed management group (9 patients, no gown techniques and rehabilitation in training room with mask). There were no differences in age, duration, and the level of impairments and ADL on admission between 2 groups. The functional outcomes were assessed from the gain of basic motion (rising, sitting, standing, transfer and walking) and ADL. The emotional feelings on isolation and any regretable feelings on rehabilitation program were studied by the direct or telephone interviews to the patients and/or their families. At the time of discharge, semi-closed management group showed significantly higher improvements in both basic motion and ADL compared to that of closed management group. In both groups, most of the patients and their families complained of feelings of loneliness and discrimination during admission. They also complained of insufficient information on MRSA infection and the need of isolation by medical staffs. The closed management group thought that their functional recoveries were not enough because of the insufficient application of rehabilitation programs due to isolation. MRSA was detected only from the door knobs and beds of the rooms of MRSA positive patient. MRSA was also detected from the hands of nurses and PTs after handling MRSA positive patients, but was not detected after washing the hands. Considering the emotional response of the patients and families, MRSA patients, except for severely infected patients, should be cared under open/semi-closed system with complete sanitation and hand washing. Repetitive explanation and counseling of the patients and families are also necessary to relieve the emotional isolation.

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